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Presbyopia-Correcting IOLs for
Cataract Surgery: Frequently
Asked Questions

Reviewed by Brian S. Boxer Wachler, MD

If you need cataract surgery, you may have the option of paying extra for new presbyopia-correcting IOLs (intraocular lenses) that potentially can restore a full range of vision without eyeglasses.

Multifocal and accommodating IOLs are the two main types of presbyopia-correcting IOLs. These IOLs may offer significant advantages over conventional single-vision IOLs, which typically provide clarity at near, intermediate, or distance ranges — but not all three at once.

For example, a single vision or monofocal IOL might enable you to see objects at a distance, but you would still need reading glasses for sharp near vision. Or you might be able to see objects close-up, but you would still need eyeglasses to drive.

IOLs that correct presbyopia are relatively new in the marketplace, so you may have questions such as:

Why would I want a multifocal or accommodating IOL for cataract surgery?

The FDA approved certain presbyopia-correcting IOLs only within the last several years. This means that, for the first time, people undergoing a cataract procedure have a chance to simultaneously correct for presbyopia and thus achieve independence from reading glasses. Remember, however, that for certain near vision activities you may still benefit from wearing eyeglasses, even if you do choose a multifocal or accommodating IOL.

But aren't presbyopia-correcting IOLs a lot more expensive? How much extra do I have to pay?

Presbyopia-correcting IOLs are more expensive because they cost more for companies to develop and produce, and because extra surgeon skill is required for a procedure that includes the use of these lenses. Also, extra care must be taken with these lenses to make sure you receive the exact right prescription for your eyes. Costs vary, depending on the lens used, but you can expect to pay up to $2,500 extra per eye. Otherwise, basic costs of cataract surgery are covered by Medicare and most other health insurance policies.

Why won't Medicare or health insurance cover the full cost of presbyopia-correcting IOLs?

A multifocal or accommodating IOL is not considered medically necessary. Medicare or private insurance typically will pay only the cost of a basic intraocular lens and accompanying cataract surgery. Use of a more expensive, presbyopia-correcting lens is considered an elective refractive procedure, a type of luxury, just as LASIK and PRK are refractive procedures that also typically are not covered by health insurance.

Can my local cataract surgeon perform presbyopia-correcting surgery?

Yes, but you need to make sure that your eye surgeon has experience with the specific presbyopia-correcting IOL chosen for the procedure. Studies have shown that surgeon experience is a key factor in successful outcomes, particularly in terms of whether you will need to wear eyeglasses following cataract surgery.

What problems are associated with presbyopia-correcting IOLs?

At a 2007 American Society of Cataract and Refractive Surgery (ASCRS) conference in San Diego, some reports indicated that even experienced cataract surgeons needed to perform enhancements for 13 to 15 percent of cases involving use of presbyopia-correcting IOLs. This means you and your surgeon must be prepared to undergo a few extra steps (if needed), if you do want independence from eyeglasses.

Enhancements don't mean that the procedure itself was a failure, because you likely will see just fine with eyeglasses even if your outcome is less than optimal. But you may need extra surgical procedures such as LASIK, or insertion of an additional IOL (piggyback lens) to perfect your uncorrected vision.

Depending on the arrangement you make with your eye surgeon, an additional fee usually is required for enhancement procedures that typically are not covered by Medicare or private health insurance.

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If you have lingering astigmatism, a procedure known as limbal relaxing incisions to flatten your eye's surface (cornea) also may be required.

Some multifocal lenses may cause vision disturbances such as glare and halos around lights at night.

In extremely rare cases, as is true with any intraocular lens and cataract surgery, you may experience permanent vision loss due to infection or other surgical complications.

How can I improve my chance of a successful outcome if I choose to undergo cataract surgery with a presbyopia-correcting IOL?

Most cataract surgeons are highly skilled when it comes to familiar techniques associated with monofocal or single-vision IOLs. But if you want a good outcome with a multifocal or accommodating IOL, you should make sure your eye surgeon is committed to this technology and has undergone appropriate training. Also, you should thoroughly discuss your IOL options, potential risks and any concerns with your eye surgeon prior to cataract surgery.

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[Page updated November 2010]